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Varicose Veins

Compression stockings did reduce symptoms. The trial was fifty people over four weeks, and that is the whole evidence base being quoted

A randomised trial of class I stockings found the symptom score falling from 8.90 to 6.37 while the untreated group stayed put. What it did not test is whether stockings change anything a patient would still care about in five years.

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In short

In a randomised controlled trial of 50 patients with uncomplicated varicose veins, four weeks of class I medical compression stockings (18 to 21 mmHg) reduced a symptom sum score from 8.90 to 6.37 (P = 0.004) while the untreated control group showed no change (7.46 to 7.67, P = 0.293), with significant improvements in pain, leg swelling and heaviness — but the trial ran for five weeks in total, could not blind participants, and measured symptoms only, so it tested relief rather than whether stockings prevent progression or avoid later treatment.

Key takeaways

  • A randomised controlled trial enrolled 50 patients with uncomplicated varicose veins (CEAP C2s to C4a), 25 to class I compression stockings and 25 to no treatment.
  • The stockings delivered 18 to 21 mmHg under the German RAL-GZ 387 classification.
  • The symptom sum score in the stocking group fell from 8.90 to 6.37 (P = 0.004); the control group was unchanged, 7.46 to 7.67 (P = 0.293).
  • Significant improvements appeared in the frequency of pain, leg swelling and the feeling of heaviness.
  • In the control group, the pain score significantly increased over the follow-up period.
  • Leg itching was numerically more frequent among patients wearing stockings.
  • The trial ran one week of baseline plus four weeks of treatment, measured symptoms by a daily app, and did not test progression, ulcer prevention or later need for a procedure.

Compression stockings are the first thing almost every patient with varicose veins is told to try, and one of the least well tested. The trial most often cited for them is small, short and worth reading in full rather than in summary.

What was tested

Published in VASA, the trial randomised 50 patients with uncomplicated varicose veins — CEAP classes C2s to C4a, meaning symptomatic varicose veins up to skin changes, without ulceration — one to one. Twenty-five wore class I medical compression stockings delivering 18 to 21 mmHg; twenty-five wore nothing. After a one-week baseline, patients recorded the frequency and severity of heaviness, pain, swelling, throbbing and itching every evening in an app for four weeks.

Symptom sum score, baseline to five weeks
GroupBaselineFollow-upP
Compression stockings (n=25)8.90 ± 4.266.37 ± 3.550.004
No treatment (n=25)7.46 ± 3.717.67 ± 4.740.293

The stocking group improved and the control group did not. Pain, swelling and heaviness each improved significantly in frequency. In the untreated group, the pain score significantly increased over the same five weeks — which is the more uncomfortable half of the result, and the half that suggests the improvement was not simply regression to the mean.

8.90 → 6.37

symptom sum score over five weeks in patients wearing class I compression stockings; the untreated group went from 7.46 to 7.67Stücker M et al., VASA, 2025

What fifty patients over four weeks cannot answer

This trial is honest about being what it is, and the gap between what it measured and what patients want to know is wide enough to state directly.

  • It cannot be blinded. Everybody knows whether they are wearing a stocking, and symptom scores are self-reported, so the placebo component of the effect is unmeasurable and certainly not zero.
  • It ran five weeks. Varicose veins are a condition of decades, and nothing here speaks to whether stockings slow progression, prevent skin damage or reduce the eventual need for a procedure.
  • The endpoint is a symptom score. It is the right endpoint for the question 'will my legs feel better', and the wrong one for 'should I wear these instead of having treatment'.
  • Fifty patients is small enough that the two groups' baselines differ visibly — 8.90 against 7.46 — before anything was done.

Where this leaves compression

The defensible claim is narrow and real: class I compression stockings reduce the symptoms of uncomplicated varicose veins over a few weeks, by an amount patients notice, in a small randomised trial. That is a reasonable basis for trying them, and it is a reason to expect relief rather than resolution.

The claim that is not supported by this evidence is that stockings are an alternative to treating the underlying vein. Nothing in a five-week symptom trial addresses recurrence, progression or the fourteen-year outcomes that separate the procedural options from one another. A patient choosing stockings over a procedure is choosing on other grounds, and should know that the trial evidence does not reach that far.

Korean national data give the scale of the population making that decision: 1,867,307 people were treated for chronic venous disease between 2010 and 2020, and the annual count rose by more than half over those eleven years. The first-line advice given to most of them rests on trials the size of this one.

Sources

  1. 1

    Stücker M, Braß D, Möckel L, Hartmann K, Rabe E

    Efficacy of medical compression stockings class I on the reduction of symptoms in patients with uncomplicated varicose veins

    VASA. Zeitschrift fur Gefasskrankheiten 2025;54(1):67-72

    doi:10.1024/0301-1526/a001163 · PMID:39585803

    https://doi.org/10.1024/0301-1526/a001163
  2. 2

    Shon S, Kim H, Kim HC, Cho S, Lee SH, Joh JH

    National trend of the treatment for chronic venous diseases in Korea between 2010 and 2020

    Annals of Surgical Treatment and Research 2023;104(1):27-33

    doi:10.4174/astr.2023.104.1.27 · PMID:36685771

    https://doi.org/10.4174/astr.2023.104.1.27